Citation and License

Arthritis Research & Therapy 2013, 15:R1
doi:10.1186/ar4127

Published: 4 January 2013

Abstract

Introduction

The aim of this study was to explore the persistence of an antibody response 1.5 years
after vaccination with 7-valent pneumococcal conjugate vaccine in patients with rheumatoid
arthritis (RA) or spondyloarthropathy (SpA) treated with different antirheumatic drugs.

Results

Of 398 patients participating in the 1.5-year follow up, 302 patients (RA, 163, and
SpA, 139) had unchanged medication. Compared with postvaccination levels at 1.5 years,
GMLs for each serotype were significantly lower in all groups (P between 0.035 and <0.001; paired-sample t test), as were the proportions of patients with protective antibody levels for both
serotypes (P < 0.001; χ2 test). Higher prevaccination antibody levels for both serotypes 23F and 6B were associated
with better persistence of protective antibodies (P < 0.001). Compared with patients with protective antibody levels at 1.5 years, those
not having protective antibody levels were older, more often women, had longer disease
duration and higher HAQ and DAS, and had a lower proportion of initial responders
to both serotypes.

Concomitant anti-TNF treatment and MTX were identified as negative predictors of the
persistence of protective antibodies among RA patients (P = 0.024 and P = 0.065, respectively). Only age 65 years or older (P = 0.017) and not antirheumatic treatment was found to be a negative predictor of protective
antibodies in patients with SpA.

Conclusions

After initial increase, 1.5 years after pneumococcal vaccination with 7-valent conjugate
vaccine, postvaccination antibody levels decreased significantly, reaching levels
before vaccination in this cohort of patients with established arthritis treated with
different antirheumatic drugs. MTX and anti-TNF treatment predicted low persistence
of protective immunity among patients with RA. To boost antibody response, early revaccination
with conjugate vaccine might be needed in patients receiving potent immunosuppressive
remedies.